Medical Verdicts

Uterine rupture follows failed VBAC attempt

A 39-year-old gravida with a previous cesarean delivery (due to twins) opted for a vaginal birth after cesarean (VBAC). She presented for induction of labor due to fetal macrosomia.

When the infant’s head was between -2 and-3 station, the fetal heart rate was noted to be nonreassuring. Medical staff initially believed this was due to normal changes within the second stage of labor, but when labor failed to progress over the next 25 minutes, the defendant physician was called.

The doctor ordered a cesarean delivery 20 minutes after his arrival; however, the procedure did not start until 20 minutes after that. In the interim, evidence of uterine rupture was noted, and the child’s heart rate fell into the 60s. The child suffered severe brain damage and cerebral palsy.

The plaintiffs claimed that had cesarean delivery been initiated at least 15 minutes earlier, neurologic injury might have been avoided.

The defendants denied the delay was unreasonable. Further, they maintained uterine rupture was a known complication of VBAC, and argued that the consent form signed by the mother explained the chance of uterine rupture and the risks associated with it.

The jury awarded the plaintiffs $14.9 million.

The cases in this column are selected by the editors of OBG Management from Medical Malpractice Verdicts, Settlements & Experts, with permission of the editor, Lewis Laska, of Nashville, Tenn (www.verdictslaska.com). While there are instances when the available information is incomplete, these cases represent the types of clinical situations that typically result in litigation.